Health Guidefor asylum seekers in Germany

Impressum Legal notice

Herausgeber Published by:

Bundesministerium für Gesundheit Federal Ministry for Health

Task Force Migration und Gesundheit

Referat Z 24 „Migration, Integration, Demografie und Gesundheit“

Migration and Health Task Force

Department Z 24 ‘Migration, Integration, Demography and Health’

11055 Berlin

www.bundesgesundheitsministerium.de

Gestaltung Design by:

eindruck.net

Ethno-Medizinisches Zentrum e.V.

Titelfoto Photograph: © Bundesministerium für Gesundheit

Druck Printed by: unidruck.de

Stand Current at: Dezember 2015 (1. Auflage) December 2015 (1st edition)

Diese Publikation des Bundes ministeriums für Gesundheit können Sie jederzeit auch in den Sprachversionen Deutsch, Arabisch, Paschto und Kurdisch-Kurmanci kostenlos anfordern: You can order this publication by the Federal Ministry for Health at any time and free of charge. It is also available in German, Arabic, Pashto and Kurdish/Kurmanji:

Online orders: www.Ratgeber-Gesundheit-fuer-Asylsuchende.de

Email: ethno@onlinehome.de

Telefon Phone: 0511 1684 1017

Schriftlich Mail:

Ethno-Medizinisches Zentrum e.V.

Königstraße 6, 30175 Hannover

Contents

1. General information about the health system . . . . . . . . . . . . . . . . . . . . . 3

Medical consultations in reception centres . . . . . . . . . . . . . . . . . . . . . . . 4

Medical treatment vouchers and electronic health care card . . . . . . 4

Relief organisations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Doctors in private practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Pharmacies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Initial examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Children and adolescents up to 18 years of age . . . . . . . . . . . . . . . . . . . 12

Dental treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2. Practical advice to protect against diseases and infections . . . . . . . .14

Regular and thorough hand washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Coughing and sneezing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Pay attention to the first signs of illness . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Annex 1: Examination record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Annex 2: Temporary vaccination record . . . . . . . . . . . . . . . . . . . . . . . . .19

3

1. General information about the health systemHealth care in Germany is based on medical insurance. When you seek asylum in Germany, you do not have medical insurance at first. Gov-ernment agencies therefore ensure your health care. These include, for example, the social services department (Sozialamt) or the public health service (Gesundheitsamt). Health care includes treatment by a doctor or dentist as well as any necessary vaccinations and medically indicated preventive examinations.

Government agencies collaborate with all health care facilities.

You will be examined and treated by a doctor if

• youareacutelyill,• youaresufferingpain,• youarepregnant.

Children, expecting mothers, victims of torture and violence as well as people with disabilities, for example, are considered particularly vulnerable. Their needs will be given particular consideration in the provision of health care.

Please keep all health care documents you receive in a safe place! These include for example, the vaccination record (Impfausweis) and the maternity record (Mutterpass). These documents contain important information that may be required for further visits to the doctor or stays in hospital.

Important:

4

Medical consultations in reception centres

In some federal states, doctors offer consultations right in the recep-tion centres themselves. Here, health care is provided locally, using a system of specific clinic hours.

Medical treatment vouchers and electronic health care card

Depending on the federal state you are in, you will receive either a medical treatment voucher (Behandlungsschein) or an electronic health care card (Gesundheitskarte).

Normally, a medical treatment voucher is valid only for a short time. You will receive this voucher from one of the government agencies (e.g. social services department – Sozialamt – or the public health service – Gesundheitsamt) if you are ill. You must present this medical treatment voucher to the doctor. If the doctor prescribes medication or wants to have you admitted to a hospital, the relevant government agency must approve this in advance.

In a few federal states, asylum seekers are given an electronic health care card (Gesundheitskarte) by a government agency or health insur-ance provider.

This electronic health care card replaces the medical treatment voucher. With this card you can consult doctors directly without first obtaining confirmation from government agencies (e.g. social services or the public health service). The health care card must be kept in a safe place.

5

Relief organisations

Relief organisations (German Red Cross/Red Crescent, Diakonia Chris-tian welfare, the Caritas Association, the ‘Malteser’ relief agency and others) offering medical care may also be present in reception centres. Please enquire whether the relief organisation in your reception cen-tre also offers or makes referrals to medical care.

Address of the government agency responsible for you

(Bitte Eintragung durch jeweilige Aufnahmeeinrichtung)

Standardised logo identifying the card

Processor chip with encryption function

Cardholder’s details (name, provider number and membership number)

Space for health insurance pro­vider’s logo

Optional ‘eGK’ (electronic health card) Braille marking

Standardised title identifying the card

Photograph of the insured person

Gesundheitskarte (electronic health care card)Front of the card

© Bundesministerium für Gesundheit

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Doctors in private practices

In general, doctors working in individual or group practices make the diagnosis and then carry out the treatment of an illness. These are called ‘niedergelassene Ärztinnen und Ärzte’ (doctors in private practices). These doctors also issue prescriptions for medicines and can refer their patients for admission to a hospital for further treatment.

Doctors in private practices bill, for example, the social services department (Sozialamt) or a statutory health insurance provider (Krankenkasse) for their services. Patients can also pay for their treat-ment at a doctor’s practice themselves. Please note that you must then bear these costs yourself. The money cannot be reimbursed to you afterwards.

Doctors must keep medical confidentiality. They are not permitted to disclose the information they are entrusted with to third parties. Cer-tain infectious diseases, e.g. tuberculosis, must be notified to the public health authority and to the Federal Agency for Migration and Refu-gees. This is the only way to prevent the spread of infectious diseases. This notification does not affect the processing of an asylum claim.

Most doctors offer consultations by appointment. You should therefore make an appointment, preferably by telephone. Make sure you keep to the agreed date and time! Patients without an appointment can usually expect waiting times.

Important:

7

Hospitals

You will be treated in a hospital only if treatment at a doctor’s practice is not sufficient. A stay in hospital (Krankenhaus) must be approved in advance. Only go to a hospital without prior consultation if it is an emergency!

Emergencies

The following are examples of medical emergencies (medizinische Notfälle):

• acuteshortnessofbreath• acutepaininthechest• acutepainintheabdomen• acutedizziness• accidentsandinjuries• complicationsduringpregnancy• acutementaldistress• acutedangerofsuicide• drug-relatedemergency• allergicshock• lossofconsciousnessorcoma.

In these cases you should seek immediate help by calling an ambu-lance or going to an emergency response centre or a doctor.

Many doctors speak English or another second language. Please enquire about this. If you speak German less well, it is advisable that you take a person you trust and who speaks the language to the doctor with you.

Important:

8

You can access emergency assistance here:

Pharmacies

In Germany, many medicines may only be dispensed to patients by pharmacies (Apotheke). You can obtain certain medicines (known as ‘prescription only’ medicines) from a pharmacist only if you present a doctor’s prescription. There are also many medicines that can be bought freely and for which no prescription is needed. The costs of these will not be reimbursed by the relevant government agency.

The pharmacist will inform you about how to take the medicine.

At least one pharmacy near you will be on duty at all times of the day and night.

Contact for medical emergencies in your reception centre:

(Bitte Eintragung durch jeweilige Aufnahmeeinrichtung)

9

This is what prescriptions may look like:

© Deutscher Ärzteverlag

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Initial examination

The initial examination (Erstuntersuchung) serves to detect and treat infectious diseases. This also prevents the spread of infectious diseases.After you arrive in your reception centre, a doctor will examine you for communicable diseases. This is a mandatory exami-nation required by law, therefore you must take part in it. It is possible that you will also be asked to complete a questionnaire (medical history form) before this examination. The doctor will ask you about symptoms of infectious diseases and will exami-ne you for communicable diseases if necessary.

The result of the initial examination does not affect the process-ing of your asylum claim!To enable pulmonary tuberculosis to be excluded, an X-ray photo of the lungs must be made. For children, adolescents under 15 years of age and pregnant women, the X-ray examina-tion is replaced with another suitable method (e.g. a blood test). Please tell the doctor if you are pregnant!Additional examinations are carried out in some federal states. For example, the purpose of a blood sample is to exclude infec-tions, and faeces samples are used to detect diarrhoea patho-gens and intestinal worm infestations.Please ensure all examinations are recorded. If you have not yet received a documentation form, you can have examinations recorded in the template provided in Annex 1 (Page 18).

Important:

11

Vaccinations

Vaccinations effectively protect people against diseases caused by bacteria and viruses. If a large number of people are vaccinated against certain infectious diseases, these can no longer spread across the population.

You may already have a vaccination document that records which vac-cinations you have already received. If you do not yet have a vaccina-tion document, you will receive a vaccination record (Impfausweis) after a vaccination by the doctor or, alternatively, an immunisation certificate as a substitute.

In Germany, there are recommendations about when certain vaccina-tions should be given. Some vaccines need to be administered several times to achieve effective protection. Therefore it may be necessary to attend several vaccination appointments. You can obtain information about this from the medical personnel in your reception centre.

Please have yourself and your children vaccinated! The vacci-nation will protect you as well as your family and other people around you from infectious diseases. This way you will prevent the spread of diseases such as measles, polio, whooping cough or influenza. Bring your vaccination document with you every time you visit a doctor. If you do not have a vaccination docu-ment, please use the temporary record in Annex 2 (Page 19) as a substitute.

Important:

12

Pregnancy

Pregnant women will receive medical care. The course of the preg-nancy and your child’s development will be monitored. This will include regular examinations (e.g. blood tests, urine tests and ultra-sound examinations), preparation for the birth, the delivery itself and aftercare. If you are pregnant, the doctor treating you will give you a maternity record (Mutterpass). The individual appointment dates/times for examinations will be recorded in this document. Deliveries are assisted by male and female midwives and also by doctors. Mid-wives are also important contacts before and after the birth.

Children and adolescents up to 18 years of age

After the birth of their child, parents will generally be given an exami-nation record describing in detail when specific examinations are due.

There is provision for several examinations for children up to six years of age. The first examination is carried out immediately after birth. Metabolism and functioning of the sensory organs (e.g. hearing and sight), breathing, digestion and musculature are checked. Attention is given to any developmental and behavioural abnormalities.

Please keep this examination record in a safe place and bring it with you every time your child visits a doctor!

Important:

13

An additional examination is recommended for adolescents between 12 and 14 years of age. The purpose of this is to detect any problems with the young person’s physical or mental development. The doctor will measure height, weight and blood pressure, among other things.

These examinations are important to promote the healthy develop-ment of your child. Therefore please make sure you attend all exami-nation appointments!

Dental treatment

Toothache and acute diseases in the mouth are treated.

14

2. Practical advice to protect against diseases and infections

Water and food supplies in Germany are monitored by the govern-ment. The quality of tap water is good, and it is entirely safe to drink.

Often, a lot of people live very close together in reception centres and accommodation facilities. You are advised to drink only from your own bottle. You should therefore put an identifying mark on your own bottle. Diseases can spread quickly in reception centres and accommodation facilities. By paying attention to cleanliness and hygiene, you can con-tribute considerably to protecting yourself and others from infections. We therefore recommend the following hygiene precautions:

Regular and thorough hand washing

Regular hand washing is an important precaution for preventing infections.

When must I wash my hands?

You should wash your hands particularly:• everytimetheybecomedirty,• beforepreparingfoodormeals,• beforemealtimes,• beforesmokinganddrinking,• aftereverytimeyouusethetoilet,• aftertouchinganimals,• aftercoughingandsneezinginto

your hand,• afterblowingyournose,• aftercontactwithwasteorgarbage. ©

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What must I pay attention to when washing my hands?

Start by wetting your hands under running water!

Completely lather up your hands with soap (preferably liquid soap, because bars of soap are often contaminated with germs)!

Lather up by rubbing for 20 – 30 seconds, especially in the spaces between the fingers and on the fingertips!

Rinse the soap off thoroughly under running water!

Dry your hands carefully with a clean towel or with disposable towels!

© Bundeszentrale für gesundheitliche Aufklärung www.bzga.de

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Coughing and sneezing

Do not cough or sneeze into your hand, use the crook of your arm or a tissue instead. Maintain a distance from other people!

Use a tissue to blow your nose, but use it only once!

Do not leave used tissues lying around or throw them on the ground. Do not put them into your trouser, jacket or skirt pocket. Do not collect them!

Used tissues belong in the waste bin!

Wash your hands often if you have a runny nose and are sneezing!

© Bundeszentrale für gesundheitliche Aufklärung

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Pay attention to the first signs of illness

If you suffer from a cold or gastrointestinal infection, there is a risk that you will infect other people. To protect yourself and those around you, pay attention to the first signs of illness: the typical symptoms of influenza are sudden high fever, feeling very ill, coughing and sore limbs. Sudden nausea, vomiting and diarrhoea can indicate a gastro-intestinal infection.

Take these symptoms seriously and contact the medical staff in your reception centre!

Important:

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Diese Druckschrift wird im Rahmen der Öffentlichkeitsarbeit des Bundesministeriums für Gesundheit kostenlos herausgegeben. Sie darf weder von Parteien noch von Wahlwerbern oder Wahlhelfern während des Wahlkampfes zum Zwecke der Wahlwerbung verwendet werden. Dies gilt für Europa­, Bundestags­, Landtags­ und Kommunalwahlen. Missbräuch lich ist besonders die Verteilung auf Wahlveranstaltungen, an Informationsständen der Parteien sowie das Einlegen, Aufdrucken oder Aufkleben parteipolitischer Informationen oder Werbe­mittel. Untersagt ist gleichfalls die Weitergabe an Dritte zum Zwecke der Wahl werbung. Unab­hängig davon, wann, auf welchem Weg und in welcher Anzahl diese Schrift dem Empfänger zugegangen ist, darf sie auch ohne zeitlichen Bezug zu einer bevorstehenden Wahl nicht in einer Weise verwendet werden, die als Parteinahme der Bundesregierung zugunsten einzelner politischer Gruppen verstanden werden könnte.

This publication is published free of charge as part of the public relations work of the Federal Ministry for Health. It must not be used by political parties, electioneers or polling assistants for promotional purposes during election campaigns. This covers European, Federal Parlia­mentary, State Parliamentary and local government elections. Particularly its distribution at election campaign events or information stalls of political parties as well as inserting, printing or attaching party political information or promotional material is considered misuse. Also prohibited is passing the publication on to third persons for the purpose of electioneering. Independent of when, how and in which quantity this publication has reached the recipient, it must not be used, even without any relationship to the timing of an upcoming election, in any way that could suggest the taking of sides of the Federal Government in favour of individual political groups.